In polytraumatic pediatric patients, life-saving or stabilizing measures must often be prioritized over permanent orthopedic solutions to a fractured extremity. The standard application of external fixation to femur fractures can be difficult in the pediatric intensive care unit setting due to the limited mobility of the patient and adaptability of C-arm radiography. We propose a technique utilizing radiopaque markers and digital radiographs in lieu of C-arm imaging to accurately plan the pin placement in a reproducible manner that eases application and reduces errant placement that may result in physeal injury.
Two patients are reported, aged 7 and 11, involved in motor vehicle accidents who sustained multiple injuries including femur fractures which were addressed with this method. Beekley Medical 7″×7.5″ Guidelines calibrated radiopaque markers were placed on the involved thigh and a single digital radiograph was performed. On the basis of preoperative templating from the radiographic markers, the fracture site and proposed pin sites were marked and the pins were placed.
Both patients eventually had the external fixators removed and underwent definitive fixation with internal fixation. They both healed with successful union of the femoral fracture.
The use of radiopaque markers reproducibly aids radiologically guided placement of threaded Shanz pins during external fixation of femur fractures in polytraumatized pediatric patients undergoing damage control orthopaedics. The technique also minimizes radiation exposure, uses equipment readily available in the hospital setting, and alleviates the need to have a radiolucent bed in the pediatric intensive care unit.
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